Cavernous Sinus Angioma: Which Is the Ideal Treatment?

Two female patients, 33-year-old and 52-year-old harboring of cavernous sinus angioma, were treated in our department. Both patients had huge voluminous cavernous sinus angioma diagnosed by MRI, angiography. The first patient was diagnosed due to pronounced proptosis in left eye, and the second one for partial complex crisis. The management was exactly the same for both patients: middle fossa approach with intraoperative neurophysiological monitoring, pealing of middle fossa, small biopsy of angioma with bleeding during the whole intraoperative period, closure of cavernous sinus wall after the frozen biopsy results, closure with a patch of temporal muscle, and hydrogel seal over the muscle sutured, and use of Floseal for hemostasia. They had an optimal postoperative course, and were discharged of Hospital in the fifth and seventh postoperative day. They were submitted to propranolol treatment 20 mg each 8 hours per day, and stereotactic fractioned radiotherapy. The follow-up showed an enormous reduction in both residual (more than 50%) angiomas. We conclude that in this disease instead of trying for total resection that could lead to oculomotor deficits as mentioned in the literature, we use a conservative approach with biopsy, propranolol, and radiosurgery. The use of propranolol is still controversial in the literature, but seems to be promising depending on results of further cases.